Pregnancy in Women with a Mechanical Heart Valve: Data of the European Society of Cardiology Registry of Pregnancy and Cardiac disease (ROPAC)
Background—Pregnant women with a mechanical heart valve (MHV) are at a heightened risk of a thrombotic event while their absolute need for adequate anticoagulation puts them at considerable risk of bleeding and, with some anticoagulants, fetotoxicity.
Methods and Results—Within the prospective, observational, contemporary, worldwide Registry Of Pregnancy And Cardiac disease (ROPAC) we describe the pregnancy outcome of 212 patients with a MHV. We compare them to 134 patients with a tissue heart valve (THV) and 2620 other patients without a prosthetic valve (NoPHV). Maternal mortality occurred in 1.4% of the MHV patients, in 1.5% of THV patients (p=1.000) and in 0.2% of NoPHV patients (p=0.025). Mechanical valve thrombosis complicated pregnancy in 10 (4.7%) MHV patients; in five of them the valve thrombosis occurred in the first trimester, and all five had been switched to some form of heparin. Hemorrhagic events occurred in 23.1% of MHV patients, in 5.1% of THV patients (p<0.001) and in 4.9% of NoPHV patients (p<0.001). Only 58% of the MHV patients had a pregnancy free of serious adverse events, versus 79% of THV patients (p<0.001) and 78% of NoPHV patients (p<0.001). Vitamin K antagonist use in the first trimester compared with heparin was associated with a higher rate of miscarriage (28.6% versus 9.2%, p<0.001) and late fetal death (7.1% versus 0.7%, p=0.016).
Conclusions—Women with a MHV have only a 58% chance of experiencing an uncomplicated pregnancy with live birth. The markedly increased mortality and morbidity warrants extensive pre-pregnancy counseling and centralization of care.
- Received January 2, 2015.
- Revision received April 7, 2015.
- Accepted May 1, 2015.